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Organization

RETINA INSTITUTE OF CALIFORNIA MEDICAL GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TOM S CHANG MD (OWNER)
(626) 568-8838
Entity
Organization

Contact information

Practice address
58471 29 PALMS HWY, 203, YUCCA VALLEY, CA 92284-5818
(760) 853-3005
(760) 853-3012
Mailing address
100 E CALIFORNIA BLVD, PASADENA, CA 91105-3205
(626) 269-5357
(626) 574-7188

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
207W00000X
Ophthalmology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1760541569
CA
Enumeration date
12/19/2016
Last updated
03/29/2021
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